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Managing Infectious Diarrheas: Pharmacotherapy Insights

Learn about the epidemiology, etiology, pathophysiology, symptoms, and treatment options for infectious diarrhea caused by various pathogens. Understand the use of antibiotics, rehydration, diet, eubiotics, and specific therapeutic agents.

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Managing Infectious Diarrheas: Pharmacotherapy Insights

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  1. Pharmacotherapy of infectious diarrheas PharmDr. Ondřej Zendulka, Ph.D.

  2. Infectious diarrhea Epidemiology • diet or direct contact with pathogen Etiology • variety of pathogens – bacteria, viruses, parasites • ATB therapy induction • most common Salmonella sp., Campylobacter sp.

  3. Infectious diarrhea Pathophysiology • dehydration, electrolyte and acidobasic imbalance • nausea and vomitus usually present • exudative diarrhea with inflammation, rarely secretory diarrhea (cholera) Symptoms • abdominal discomfort – loss of appetite, flatulence • number of stools from 1 to tens per day • sometimes only painful tenesmuses • fever

  4. Infectious diarrhea Salmonella • most common is S. enteritidis • source: infected food • incubation period: 8-48h • symptoms: abdominal pain, fever, stool gets dark green colour • therapy: cotrimoxazol, quinolones, aminopenicillines http://www.youtube.com/watch?v=j5GvvQJVD_Y

  5. Infectious diarrhea Campylobacter • 90% by C. jejuni • source: infected food or direct transfer • incubation period: 1-7 days • therapy: macrolides, (quinolones)

  6. Infectious diarrhea Shigella • 95% by S. sonnei • source: infected food or direct transfer • incubation period: 1-3(7) days • symptoms: fever, abdominal pain prior defecation, vomiting • therapy: serious infections ATB (aminopen, cotrimoxazol, quinolones), rehydratation

  7. Infectious diarrhea Viral diarrheas • pathogen: rota-, adeno-, astro-,kalci-, toroviruses • source: contaminated objects, direct contact • incubation period: 1-2 days • symptoms: mild infections, !children, elderls • therapy: symptomatic

  8. Infectious diarrhea Parasitic diarrheas • rarely: Giardia lamblia, Ascaris lumbricoides • therapy: metroniadzole, mebendazole, albendazole

  9. Infectious diarrhea ATB associated diarrheas • type of ATB and period of administration plays role • intestinal dysmicrobia • pseudomembraneous colitis • linkosamides, penicillines, cephalosporines, quinolones • therapy: metronidazole, vancomycin

  10. Infectious diarrhea - therapy Rehydration • black tea, still mineral water (nonlaxative) • rehydration solution: 1L of water 8 spoons of sugar 1 spoon of salt juice from 2 oranges drink 250-500 ml/hour

  11. Infectious diarrhea - therapy Diet • individual with regard to tolerance • lipid restriction • possible decrease in absorption of drugs (peroral contraception) • diet bisquits, potatoes, rice, bananas, apples

  12. Infectious diarrhea - therapy Eubiotics • increase of intestinal enzyme activity • intreference with pathogen microflora • immunomodulants • probiotics – Lactobacillus, Bifidobacterias, Sacharomycetes • prebiotics – oligo- and polysacharides

  13. Infectious diarrhea - therapy rifaximin (NORMIX) • inhibits DNA dependent RNA polymerase • wide spectrum • absorption from GIT 1% • flatulence, abdominal pain, loss of weight • prophylaxis prior to surgery on intestine

  14. Infectious diarrhea - therapy nifuroxazid (Endiex, Ercefuryl) • interferes with synthesis of NA and bacterial metabolism • not active against: Proteus, Pseudomonas, Enterobacter • not absorbed from GIT • flatulence, abdominal pain, loss of weight • prophylaxis prior to surgery on intestine

  15. Infectious diarrhea - therapy chloroxine (Endiaron) • significant bacteriostatic, fungistatic and antiprotozoal properties • does not induce resistance • does not influence natural intestinal flora • not for children less than 40kg

  16. Infectious diarrhea - therapy Antimotility agents loperamide (Imodium, Loperon) • opioid receptor agonist • no influence on microflora • high afinity to intestine, low bioavalability, high first pass effect • urticaria, rush, constipation + diosmectite (Imodium plus) - natural silicate, intestinal absorbent

  17. Infectious diarrhea - therapy Antimotility agents diphenoxylate (Reasec) • pethidin similar + atropin in subtherapeutic dose Intestinal absorbents • diosmectite (Smecta) • activated charcoal (Carbocit, Carbosorb) - 1-2 tablespoons, 3-4x day

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